tbuckley/cabot-search huggingface dataset:
COVID-19 clearance among patients with cancer during the Delta and Omicron waves.
Authors: Zachary M Avigan, Rodrigo Paredes, Leora S Boussi, Barbara Lam, Meghan Shea, Matthew Weinstock, Mary Linton Bounetheau Peters
Journal: Journal of Clinical Oncology (2022)

42 Background: COVID-19 presents a particular challenge in oncology, as in-person visits and treatments can be delayed during infection and patients are at risk for prolonged viral shedding. Our center uses two consecutive negative PCR tests for patients to return to clinic. As vaccination rates increase, we questioned the need for this strategy vs a time-based clearance approach. Methods: We identified cancer patients who tested positive for COVID-19 from 10/1/2021 to 3/31/2022 at a single tertiary care center and performed chart review under an IRB-approved protocol. Subgroups were compared using the Welch’s t-test and Welch’s ANOVA for 2 or &gt; 2 groups, respectively. Results: 169 patients were identified. 153 had documented clearance defined as two consecutive negative PCR tests. The mean clearance time was 35.7 days (95% CI 32.3-39.0). There was a trend toward longer clearance time in patients with hematologic vs solid tumors (39.6 vs 33.2, p =.06) and a significant increase in patients treated with B cell depletion (58.0) vs chemo/targeted therapy (35.7, p =.01) or immunotherapy (29.0, p =.004). No significant difference was found by vaccination status or between the Delta and Omicron waves. If defined as one negative test, mean clearance time was 25.9 days (95% CI 23.6-28.1), and there was a significant difference in patients with hematologic vs solid tumors and in those treated with B cell depletion vs other therapies. However, 16.0% (27/169) of patients had a subsequent positive test after a first negative result, with increased incidence in patients with hematologic malignancy (26.2%, 16/61) and stem cell/adoptive cell transplant (46.2%, 6/13). Conclusions: COVID-19 is a significant barrier to oncologic care, and clearance times remain longer than reported for the general population. In this single center study, clearance time was &gt; 1 month and further increased in patients with hematologic malignancy or on B cell depleting therapy. While adjusting clearance criteria to a single negative test or specific timeframe may be an attractive option to reduce delays, a large proportion of patients may have further positive PCR testing.[Table: see text]
Patient-reported outcomes in a linguistically diverse cancer population: Addressing barriers to access.
Authors: Fatima Usman, Rebekah Rittberg, Howard John Lim, Eric Bhang, Brandon Chan, Deepu Alex, Stephen K.L. Chia, Karamjit Gill, Jenny J. Ko, Jason KoLeong, Janessa J. Laskin, Jonathan M. Loree, Barbara L. Melosky, Mehrnoosh Pauls, Samantha Pollard, Ying Wang, Deirdre Weymann, Stephen Yip, Dean A Regier, Cheryl Ho
Journal: Journal of Clinical Oncology (2022)

168 Background: The census metropolitan area served by BC Cancer is Vancouver which has a population of 2.4 million. Census Canada noted the mother tongue learned in childhood and still spoken was: 54% English, 17% Indo-European, 16% Chinese, 10% Indo-Iranian, 3% English+other language, 2% other. At BC Cancer, implementation of patient reported outcomes (PROs) was launched 1 year ago with consideration of preferred language. Our goal was to examine the implementation of PROs with respect to equity of access and language preferences. Methods: BC Cancer Vancouver implemented PROs including the Edmonton Symptom Assessment Scale Revised, Canadian Problem Checklist and EQ5D in April 2021 using a web-based platform. A 1-year cohort was reviewed for patients’ mother tongue and the language used for the PROs. Qualitative interviews were undertaken for non-English mother tongue patients to ask for preferred language of PROs and reasons for the choice if mother tongue was not selected. Results: 86 patients were enrolled in the PRO program. Baseline characteristics: 66% female, age 30% &lt; 60/ 31% 60-69/ 39% &gt;70, primary site 54% lung/ 34% colorectal/ 18% other. Ethnic origin: 53% North American and European, 40% East and Southeast Asian, 2% Latin/Central and South American, 3% South Asian, 1% Indigenous, 1% other. Mother tongue: 52% English, 48% non-English (39% English proficient, 9% low English proficiency). Patient preferred language for PROs: 81% English, 11% Chinese, 7% other. Reasons for non-English mother tongue preference for English language included comfort with written English, use of family assistance completing questionnaires for both language and familiarity with electronic devices. Conclusions: In the Vancouver linguistically diverse cancer population, the majority of patients preferred English language PROs. Reasons for this include proficiency in the written language and the use of family members to complete the questionnaires. With 39% of patients over the age of 70 in our study, the use of electronic devices for completion may have introduced an additional barrier to access. In clinic iPad questionnaires with nursing and care aide support have been introduced to help address this gap. Clinical trial information: NCT05057234.
Survival of the Hmong population diagnosed with colorectal cancer in the United States.
Authors: Margaret Walker, Noelle K. LoConte, Kajua B. Lor, John M. Hampton, Andrea M Schiefelbein, Kha Lor, Molinna Bui, Roberto J. Vidri
Journal: Journal of Clinical Oncology (2022)

152 Background: The Hmong people constitute an Asian-American subgroup, accounting for 0.1% of the United States (US) population. Originating from Laos and Vietnam, Hmong individuals fought as secret soldiers for the US during the Vietnam War and later immigrated to the US, with the largest settlements in Minnesota, Wisconsin, and California. The Hmong population has faced various health disparities in the domains of mental health, chronic disease, and cancer. This study seeks to investigate trends in colorectal cancer (CRC) survival in the US Hmong population. Methods: Cases of colon and rectal adenocarcinoma diagnosed between 2004-2017 were identified within the National Cancer Database. Summary statistics of demographic, clinical, socioeconomic, and treatment variables were calculated. Multiple Cox proportional hazard models were constructed using sets of demographic, clinical, socioeconomic, and treatment variables to identify factors associated with overall survival (OS) within the Hmong population diagnosed with CRC. Results: One hundred and twenty (0.01%) Hmong individuals were identified within a total of 881,243 CRC cases. Their average age at diagnosis was 58.9 years, compared 68.7 years for Non-Hispanic White (NHW) individuals (p &lt; 0.01). Over half of Hmong individuals (52.5%) were diagnosed with Stage III or VI disease (NHW, 42.5%, p &lt; 0.03), and they more frequently resided in the lowest median income quartile (p &lt; 0.01), the lowest high school degree achievement quartile (p &lt; 0.01), and had higher rates of Medicaid coverage (p &lt; 0.01) compared to NHWs. When adjusting only for age, sex, stage, and Charlson-Deyo comorbidity score, Hmong individuals had a greater hazard of death compared to their NHW counterparts (HR 1.43, p &lt; 0.01). However, in a multivariable model accounting for all variables suspected to be associated with CRC outcomes, OS was similar between these groups (HR 1.01, p &lt; 0.93). Conclusions: Hmong individuals diagnosed with CRC appear to have similar overall survival to Non-Hispanic Whites despite belonging to lower socioeconomic groups, being diagnosed at a younger age and with a higher proportion of Stage III/VI disease. This may point to a robust response to treatment and resilience within the Hmong community. Future efforts will focus on disseminating this information and developing community-based approaches for health screening and prevention.
Clinical uptake of precision medicine advances in NSCLC: A case study in <i>RET</i> fusions.
Authors: Krista Marcello, Taofeek K. Owonikoko, Karen L. Reckamp, Laura J. Tafe, Rachael Andrie, Kevin Obholz
Journal: Journal of Clinical Oncology (2022)

32 Background: Precision medicine has revolutionized cancer care in advanced NSCLC and new actionable biomarkers and targeted therapies are emerging at an unprecedented pace, creating myriad opportunities to improve care and mitigate the often-dire sequelae of traditional cancer therapy. Delays in uptake of testing and biomarker-guided treatment for patients with NSCLC and EGFR activating mutations or ALK fusions are well documented despite clear evidence-based practice, guidelines, and expert recommendations. In this study, we analyze healthcare professionals (HCPs) awareness and application of RET fusion testing and integration of recently approved selective RET inhibitors into practice for appropriate patients with advanced NSCLC. Methods: From 1/2020-6/2022, multiple educational activities were developed to provide HCPs with evidence-based expert and guideline recommendations on assessment of and therapy selection for RET fusion–positive NSCLC. The activities comprised live symposia associated with 4 major oncology and pathology conferences (AMP, USCAP, ASCO, AACR), 3 regional live workshop series across the US, 3 live webinars, and 2 on-demand videos. Baseline polling questions designed to assess key aspects of HCP knowledge and practice patterns were repeated at each activity. Results: Across all activities at baseline, on average only 38% of responding HCPs correctly identified RNA NGS as the most sensitive testing assay for detection of RET fusions and 36% accurately selected the appropriate targeted therapy for patient case with a KIF5B-RET gene fusion. From 2020 through 2022, with each new group of learners across different scopes of practice, we found suboptimal awareness of optimal RET fusion testing methodology and choice of therapy for patients with RET fusion–positive NSCLC (table). Optimal responses were slightly higher among learners attending conference-associated symposia vs live workshop series and online education. Conclusions: The use of optimal testing assays for RET alterations across patients with NSCLC remains low and many HCPs continue to lack awareness of appropriate targeted therapy for patients with RET–fusion positive NSCLC &gt; 2 years after the first approved indication for this biomarker. These results underscore a lag in adoption of optimal precision medicine approaches for NSCLC among oncology HCPs and the need for expert guidance and educational activities to optimize individualized, biomarker-driven treatment approaches. An analysis of patterns by HCP role (MD, NP/PA, RN, Pharmacist) will be presented.[Table: see text]
Improving documentation of zoledronic acid interval in ambulatory oncology patients.
Authors: Tanvi Dandawate
Journal: Journal of Clinical Oncology (2022)

323 Background: Therapy plan orders for certain repetitive medications such as Zoledronic Acid do not always reflect the interval administered. This creates a patient safety risk as patients may get extra or fewer doses than required, a lack of clarity for pharmacy dispensing and nurses administering the medication and delays for patients while the orders are corrected. In a 3-month period, 30 safety reports of Zoledronic Acid therapy plan discrepancies were reported. Methods: Baseline data was determined using manual chart review of a sample of 50 patients, reviewing documentation of Zoledronic Acid interval in four fields in the chart. 58% of patients had an incorrect interval in therapy plan title and 12% of charts had discrepancies in other fields. In initiating this improvement project, we identified and engaged key stakeholders (nurses, providers, IT, patient safety and pharmacists) in DFCI oncology outpatient areas in a series of interactive meetings to share baseline data and use quality improvement tools (process mapping and impact-effort matrix) to identify solutions. In PDSA cycle 1, the options of Zoledronic Acid therapy plans were modified from having separate plans for each interval to a single therapy plan with options to select the interval. This was done with the goal of reducing the number of fields with the interval to reduce discrepancies in interval. In PDSA cycle 2, a team of pharmacists reviewed charts of patients who had an appointment with a provider and were on Zoledronic acid weekly, for 12 weeks. Charts with interval discrepancies were sent to the ordering provider for correction. This was done for two disease groups over a period of 6 months. Results: Post the completion of PDSA cycle 1, an analysis of 7165 dispenses showed that Zoledronic Acid therapy plans containing information apart from medication name in title decreased from 90% in 2019 to 0.4% in 2021. PDSA cycle 2 addressed discrepancies in another 126 patient charts, reducing the overall discrepancies from 12% to 7%. Conclusions: This project demonstrates multidisciplinary approach to identifying solutions to discrepancies around Zoledronic Acid intervals in patient charts has reduced this patient safety risk. The solutions implemented in PDSA cycle 1 was a system-based solution with a high impact. PDSA cycle 2 helped mitigate the safety risk further. Additional system-based solutions are essential in the long term to reduce documentation variability and improve quality and safety of care for patients receiving Zoledronic Acid.
Persistent racial and ethnic inequities in cancer-specific mortality of head and neck cancers by human papillomavirus infection.
Authors: Abdullah Islam Abdelaziz, Gregory Sampang Calip
Journal: Journal of Clinical Oncology (2022)

148 Background: Overlapping racial and ethnic disparities exist in the prevalence of risk factors that drive the prognosis of head and neck cancers in the US, including the use of tobacco products, socioeconomic status and human papillomavirus (HPV) infection. Our objective was to describe inequities in cancer-specific survival among patients diagnosed with head and neck cancers by HPV status and racial/ethnic group. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology and End Results Head and Neck with HPV Status Database. Patients diagnosed with first primary cancers of the hypopharynx, nasopharynx, oropharynx, pharyngeal tonsil, other pharyngeal, soft palate and tongue base between 2010 and 2016 were included, and information on clinical and demographic characteristics including tumor information, cancer-directed treatment, area-level socioeconomic status and HPV status were collected from population-based cancer registry data. Estimates of 5-year cancer-specific survival were calculated using the Kaplan-Meier method, and multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for racial/ethnic inequities in survival stratified by HPV status. Results: Among 15,393 patients diagnosed with head and neck cancer with documented HPV status, the median age was 59 years (interquartile range 53-66) and 10,457 (68%) were HPV+. Compared to patients diagnosed with HPV- head and neck cancers, a higher proportion of patients with HPV+ head and neck cancers were male (87% vs. 77%), diagnosed at stage IV (75% vs. 66%) and non-Hispanic White (84% vs. 68%%); and a lower proportion of HPV+ patients were non-Hispanic Black (6% vs. 13%) and uninsured or had Medicaid coverage (13% vs. 25%). Overall, 5-year cancer-specific survival was higher among HPV+ patients (82%) than among HPV- patients (62%), with a wider disparity observed among Black head and neck cancer patients (HPV+ 74%, HPV- 44%). In multivariable models, significant differences in cancer-specific survival were found across racial/ethnic groups and HPV status (P-interaction: 0.045). Compared to White patients, persistent inequities in cancer-specific survival were observed among Black HPV+ (HR 1.49, 95% CI 1.19-1.87) and HPV- (HR 1.42, 95% CI 1.21-1.66); and among Latinx HPV+ patients (HR 1.32, 95% CI 1.03-1.69). Conclusions: In this population-based study of patients with head and neck cancers, significant disparities in cancer-specific survival were observed that differed by both race/ethnicity and HPV status. The complex inequities in outcomes of head and cancers likely reflect the clinical impacts of socioeconomic and demographic risk factors in addition to HPV-related dysregulation of tumor metabolism and the immune microenvironment.
Reasons for declining a pharmacist-led telehealth study among oncology patients initiating oral anti-cancer drugs.
Authors: Morgan RL Lichtenstein, Erik Harden, Nicole Collins, Khadija Faheem, Peter Campbell, Khilna Patel, Michelle K. Nguyen, Rachel Abramova, Melissa Parsons Beauchemin, Dawn L. Hershman
Journal: Journal of Clinical Oncology (2022)

94 Background: During the COVID-19 pandemic, remote cancer care, and video communication in particular, has become increasingly common in the context of routine visits and clinical trials. Though this medium has the potential to augment patient-provider communication, telehealth also raises concerns about the digital divide promoting disparities in access to cancer care. In this study, we surveyed oncology patients who declined to participate in a pilot study looking at a one-time pharmacist-led video visit for patients initiating oral anti-cancer medications to evaluate their primary reason for declining the intervention. Methods: Between June 2021 and June 2022, we conducted a prospective survey among adult oncology patients at Columbia University Medical Center (CUMC) who declined a pilot study looking at a video visit intervention for patients initiating oral anti-cancer medications to assess the primary barriers to participation. The survey categorized specific reasons for decline into telehealth-related barriers (no access to electronic device, inability to navigate video visits specifically, patient preference for in person care) and trial-related barriers (patient too tired/unwell, no time to participate, not interested in this study specifically, not interested in clinical trial participation in general), and patients were asked to select the primary reason for declining among the list of options. Results: Twenty-three patients completed the survey (82% completion rate). Among 23 respondents, 9 patients (39%) described a technology-related barrier to participation, including 7 (30%) who owned a mobile device with video capacity, but did not know how to use video technology well enough for the visit, 1 (4%) who did not own a device with video capacity, and 1 (4%) who preferred in person visits. Fourteen respondents cited a reason unrelated to telehealth for declining participation, including 7 (30%) who did not feel the study would benefit them, 3 (13%) who did not have time, 2 (9%) who were too tired to participate in a study, and 2 (9%) who were not interested in participating in any kind of clinical trial. Conclusions: Video-based telehealth visits have become increasingly common in routine cancer care and clinical trials. Among oncology patients who declined participation in a pilot study looking at a pharmacist-led video consultation, over a third cited telehealth-related barriers to participation, the majority of whom had a mobile device, but did not know how to use video technology well enough to participate. Focusing efforts on training patients to use technology, particularly video communication, may help address the digital divide in cancer care.
Reducing time to antibiotics in patients with neutropenic fever on a bone marrow transplant unit.
Authors: Regina McGuire, Christopher Anand Gardner, Jordan Villars, William O'Hara, Jessica Radicke, Felicia Rivera, Jill Cristiano, Joanne E. Filicko-O'Hara, Usama Gergis, Adam F Binder
Journal: Journal of Clinical Oncology (2022)

310 Background: Timely administration of antibiotics in patients with neutropenic fever (NF) is essential for reducing morbidity and mortality among oncology patients. Due to their immunocompromised state, neutropenic patients are at particularly high risk of developing severe complications from infection. The optimal time to antibiotics (TTA) for patients with NF is unclear, but IDSA/ASCO guidelines recommend a median TTA within one hour of documented fever. This study focused on identifying barriers at a single academic institution to timely antibiotic administration for patients admitted to the inpatient Bone Marrow Transplant (BMT) unit, and implemented new processes to reduce median TTA to less than 60 minutes. Methods: Patients who developed NF during their hospital admission were included in the study. Individuals who were transferred from another facility or presented to the Emergency Department with NF were excluded. Chart reviews were performed to identify root causes for delays in antibiotics (abx). Data was collected for the following time points: time from fever to notification of provider, time from notification to abx order, time from order to release, and time from release to administration. The research team also met with key stakeholders from nursing, pharmacy, advance practice providers, and physicians to better understand the process. Results: Based on the root cause analysis, 4 interventions were implemented: cefepime was stocked in the pyxis (Int 1 – August 2018), NF guidelines were updated (Int 2 – October 2019), Educational videos were created for just in time learning for house staff rotating on the oncology services and an education campaign for the nursing staff (Int 3 – June 2020), a nurse driven protocol to release and administer abx was piloted on the BMT (Int 4 – December 2021). Baseline TTA was 128 minutes. After Int 1, median TTA decreased to 77.2 minutes. Int 2 and Int 3 did not improve median TTA. In October 2020, median TTA had increased to 98 minutes. After Int-4, on the BMT unit, median TTA decreased to 40 minutes. Conclusions: Through iterative changes and process improvement methodology, we were able to improve our median TTA from 128 minutes to 40 minutes. The most impactful changes “simplified the process” to administer abx. Educational initiatives were less impactful, which is consistent with human factor re-engineering science and change management strategies. This improvement initiative spanned over an extended time period largely because of interruptions due to the COVID pandemic. As a result, the project demonstrated that the goal to implementing and sustaining change requires workflow redesign, culture shifts, and engagement by all key stakeholders.